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Ophtho 2 > Posterior Chamber and Retinal Disorders > Flashcards

Posterior Chamber and Retinal Disorders Flashcards

1
Q

What happens in Retinal Detachment?

A

retinal tear fluid vitreous passes through the tear and lodges behind the sensory retina combined traction and pull of gravity results in progressive detachment

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2
Q

Predisposing Factors of Retinal Detachment

A

-50-75years old -myosis -cataract extraction -trauma -Family history -advanced diabetes

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3
Q

Where does retinal detachment usually begin? What type of vision is lost?

A

superior temporal area central vision remains intact during initial tear, once the tear progresses to the macula central vision is lost.

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4
Q

Signs and Symptoms of Retinal Detachment

A

-blurred vision in one eye becoming progressively worse -floaters (large horsefly) -flashing lights caused by tugging on retinal surface **NO PAIN, NO REDNESS

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5
Q

What does retinal detachment look like on fundoscopic exam? -initial -progressive

A

-wrinkled/bubbled wallpaper - gray cloud

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6
Q

Treatment of Retinal Detachment

A

-REFER to OPHTHO!!! –cryotherapy –scleral buckle –intravetral gas –vitrectomy

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7
Q

Central Retinal Artery Occlusion -what is this? -aka -predisposing factors

A

-emboli enter and occlude the retinal artery Stroke of the Eye Predisposing factors: -age, 60-80years generally, may happen sooner -carotid artery disease -atrial fibrillation -HTN -Diabetes -Temporal Arteritis

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8
Q

What does CRAO look like on fundoscopic exam?

A
  • cherry red spot: macula/fovea (cherry) with pale background (ischemic/dead). Macula=cherry d/t blood supply from Choroid and rest of retina blood supplied from central retinal artery. -arteriole narrowing -PALLOR of optic disc -boxcar segmenting***(PANCE!!!!!!!) -afferent pupillary defect
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9
Q

Signs and Symptoms of CRAO

A

-sudden profound monocular visual loss (seconds, minutes, perminant) -can be preceded by amarousis fugax (transient stroke) ** this is the warning sign of CRAO -painless -no redness -visual acuity impairment (can detect hand movements but cant count fingers)

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10
Q

Treatment of CRAO

A

-REFER TO OPHTHO!! *prognosis for vision is very poor! (especially if not resolved in 90mins) -ocular massage -anterior chamber paracentesis -revascularization technique –thrombolysis

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11
Q

Retinal Vein Occlusions -predisposing factors –systemic & Ocular

A

Systemic- -increasing age -HTN -Coagulation disorders -diabetes Ocular- -raised intraOCULAR pressue (>25mmhg) -vein inflammation (vasculitis)

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12
Q

Signs and Symptoms Retinal Vein Occlusion

A

-visual impairment noticed upon waking** (PANCE!!!!) -sudden monocular loss of vision -PAINLESS -diagnosis can be made w/ ophthalmoscopic exam

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13
Q

What does RVO look like on fundoscopic exam?

A

-minimal Afferent Papillary Defect (APD) -venous tortuosity/dilation -cotton wool spots -mild to moderatae disc edema -macular edema -varicose veins (dilated)

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14
Q

Treatment of RVO High risk for what disease?

A

-REFER!!!! -make sure ongoing follow-up is established with Ophtho. High risk for- neovascular glaucoma/ proliferative retinopathy

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15
Q

What is neovascular glaucoma? Tx of this.

A

-development of new little tiny vessels to fulfill the ischemic areas. These new vessels are weak and leaky so they b leed out raising the intraOCULAR pressure in the eye leading to glaucoma. -laser therapy may be good for treating this.

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16
Q

Amaurosis Fugax -what is this?

A

-monocular vision loss lasting a few minutes with COMPLETE recovery. -caused from retinal emboli from IPSILATERAL carotid disease. -TIA of the eye.

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17
Q

Signs of Amaurosis Fugax

A

curtain passing VERTICALLY across field of vision leading to complete loss of vision, similar curtain effect as the vision returns. (PANCE!!!!!!)

18
Q

Diagnostic Testing and Labs of Amaurosis Fugax

A

-doppler US of carotids -CT/MRI angiography -EKG (rule out A. Fib) -Echo Labs- -CBC -Fasting Blood sugar -ESR and CRP -Lipid Profile

19
Q

Amaurosis Fugax Differential Dx

A

-impending central retinal artery/vein occlusion -impending OPHTHALAMIC artery occlusion (total retinal blanching) -carotid stenosis (bruit) -temporal arteritis (Giant Cell Arteritis) -ocular migraine (scintillating scotoma)

20
Q

Treatment of Amaurosis Fugax

A

-ocular massage

21
Q

Optic Nerve Neuritis Key clues

A

-young patient with vision loss and no immediate obvious exam findings -pain w/ eye movements

22
Q

Signs and Symptoms of Optic Neuritis

A

-unilateral decreased vision over 1-3 days -occasional pain w/ eye movement -age 18-45 -complete loss of color vision -afferent pupillary defect *these 2 return on own 95% of the time. -Uhtoffs Sign (worsening of neurologic symptoms in MS d/t increased body temperature on nerve conduction, this is painful)

23
Q

Etiology of Optic Neuritis

A

-Multiple Sclerosis –optic neuritis is often initial manifestation of MS -idiopathic -Viral infection, TB, sarcoidosis

24
Q

What does Optic Neuritis look like on fundoscopic exam?

A

-optic nerve normal, may be swollen but less common -relative afferent pupillary defect -decreased color vision -

25
Q

Optic Neuritis Work up and Tx

A

Work up: -complete ophthalmic exam –pupils, color vision, decreased light brightness sensitivity w/ penlight, visual field test. -complete neurologic exam/ MRI & possible IV** steroids (dont use oral steroids–malpractice d/t not aggressive enough, *anything w/ MS you use IV steroids) (PANCE!!!!!!!) -check BP -ESR, CRP, TA bx if suspect Giant Cell Arteritis (if>55yo)

26
Q

Optic Neuritis/MS MRI findings

A

-may have white plaques in multiple areas or they may not be present at all. -May not get true diagnosis for 15 years

27
Q

Papilledema -etiology

A

-intracranial tumors -hydrocephalus -pseudotumor (young obese females) -subdural hematoma (trauma) -Brain abscess/ Meningitis

28
Q

Signs and Symptoms of Papilledema

A
  • slow vision loss from increased ICP/optic nerve swelling
  • can have acute attacks of vision when lying flat
  • usually bilateral
  • disc margins blurred
  • peripapillary disc hemorrhages
  • may have dbl vision if CN VI palsy from increased ICP
29
Q

Treatmen of Papilledema

A

-directed at underlying cause

30
Q

What would you see on Fundoscopic exam of Giance Cell Arteritis?

A

relative afferent pupillary defect

pale, swollen optic disc

31
Q

Labs to order: Giant CEll arteritis

A
  • difficult to make this diagnosis w/o labs
  • ESR (

* usually these are REALLY high, pretty significant lab abnormality.

*go by symptoms; ESR and CRP can be NORMAL in 20% of patients.

32
Q

Definitive Dx of GCA

A

Temporal Artery biopsy

Histology shows granulomatous inflitrate of internal eslastic lamina of artery. –occlusion of vessel lumen, giant cells present

33
Q

Tx of GCA

A

-steroids even before biopsy is done (prednisone po qd)

*dont wait for biopsy if suspicious*

  • tx is to preserve visual loss of the other eye
  • if severe sx or visual loss:

1gm solumederol IV x3-5 days then SLOW taper off oral steroids over 2weeks.

-refer to surgery for biopsy!

34
Q

What is Giant Cell Arteritis?

A

arteries that become inflamed causing them to swell and sometimes decrease blood flow, this decrease in flow leads to vision loss that may be perminant.

35
Q

Age Related Macular Degeneration

  • Types
  • what happens
A
  • 90% dry (slower onset/gradual), 10% wet (sudden)

What happens:

  • “wearing out” of retina/photoreceptors
  • DRY: degredation products from drusen (white/yellow deposits) in retina beneath macula- - macula degernates over time
  • WET: neovascularization under the retina growing towards the macula causing it to lift up and pull away from its base.
  • rare before 50yo
  • most common in caucasions
36
Q

Age Related Macular Degeneration

-Risk Factors

A
  • age
  • smoking
  • family hx
  • caucasian
  • sun exposure
  • diet
  • HTN
  • atherosclerosis
  • cataract surgery
37
Q

Age Related Macular Degeneration Pt compaints of Wet type

A
  • acute disortion of vision, especially distortion of straight lines or loss of central vision (amsler grid)
  • symptoms usually appear in one eye although disease is generally in both eyes
38
Q

Ways to minimize the effects of Age related macular degeneration

A
  • quit smoking
  • control CVD
  • healthy diet
  • antioxidants
39
Q

Tx of Age Related Macular Degeneration

A
  • monitor vision on amsler grid
  • antioxidants may prevent cellular damage to retina
  • Vit C &E
  • beta carotene
  • zinc
  • copper
40
Q
A

Ophtho 2 (7 decks)

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